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Ortho > Ortho Infections > Flashcards

Ortho Infections Flashcards

1
Q

Why is staph aureus having an increased resistance to antibiotics?

A

Plasmids

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2
Q

When do bacteria enter the body?

A

Altered hemostasis

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3
Q

In regards to blood supply, when does the risk of infection increase?

A

Decreased blood supply

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4
Q

What increases microcirculation & vasodilation?

A

Warming of the source of infection

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5
Q

How does a traumatic injury & the presence of implants increase the risk of infection?

A

Periosteal injury, micro/macrovascular compromise
Bacteria have affinity for exposed sites
Form glycocalyx capsule
Impair normal immune function & abx penetration

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6
Q

Factors that Decrease Local Immune Responses

A

Decreased blood flow
Neuropathy
Trauma
Medication

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7
Q

Medications that can Decrease the Local Immune Response

A

NSAIDs
Rheum
Steroids

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8
Q

Factors that Decrease the Systemic Immune Response

A 
Renal & liver disease
DM
ETOH
Rheum diseases
Immunocompromised state
Malnutrition
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9
Q

Diagnostic Test with Musculoskeletal Infections

A

H&P
Labs
Culture of fluid or tissue

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10
Q

Presentation of a Musculoskeletal Infection

A 
Pain
Warmth
Swelling
Redness
Refusal to bear weight (esp. children)
Fever/chills
Night sweats
N/V
Loss of joint motion
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11
Q

Labs to Diagnose Musculoskeletal Infections

A 
CBC with differential
ESR
CRP
Blood cultures
Gram stain
Frozen section
PCR: polymerase chain reaction
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12
Q

When does ESR elevate in infection?

A

Within 2 days of infection

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13
Q

When does CRP elevate, peak, and return to normal in an infection?

A

E: within 6 hours
P: 48 hours
Return: 1 week after appropriate treatment

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14
Q

What is the best indicator for diagnosis & monitoring treatment of an infection?

A

CRP

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15
Q

What diagnostic modality has shown to be helpful in peri-prosthetic infections?

A

IL-6

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16
Q

Things you can see on Plain Films for Musculoskeletal Infections

A

Soft tissue swelling
Loss of tissue planes
Bony changes (40+% loos to see)
Brodies Abscess

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17
Q

Other Radiologic Tests to Detect Musculoskeletal Infections

A 
Bone scan: vague
Indium 111 leukocyte nuclear scan
Gallium citrate scan
PET scan
MRI
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18
Q

What diagnostic modality is used frequently for infection?

A

MRI

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19
Q

When do musculoskeletal infections frequently happen?

A

Open fractures
DM
Recent surgery

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20
Q

Describe Hematogenous Osteomyelitis

A

Osteomyelitis which was transferred by the blood

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21
Q

Desccribe Contiguous Focus Osteomyelitis

A

Infection caused by a prior infection

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22
Q

Classification of Musculoskeletal Infections that Describes the Anatomic Involvement

A

Stage 1: medullary
Stage 2: superficial
Stage 3: localized
Stage 4: diffuse

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23
Q

Classification of Musculoskeletal Infections that Describes the Host

A

Normal
Compromised
Treatment worse than disease

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24
Q

Most Common Sites of Hematogenous Osteomyelitis

A

Vertebrae***
Long bones
Pelvis
Clavicle

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25
Q

Vertebral Osteomyelitis

A

50+

May involve 2 vertebrae + disc

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26
Q

Most Common Bug with Hematogenous Osteomyelitis

A

S. aureus

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27
Q

Most Common Bugs in Vertebral Osteomyelitis

A

S. aureus

Pseudomonas (IVDU)

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28
Q

Presentation of Vertebral Osteomyelitis

A

Fever
Pain over area
Possible: meningitis, abscesses

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29
Q

Most Common Reasons for Contiguous-Focus Osteomyelitis without General Vascular Insufficiency

A 
Trauma with direct contact to bone
Infection from soft tissue
Nosocomial infection
ORIF
Prosthetics
Open fractures
Chronic soft tissue infections
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30
Q

When does a continguous-focused osteomyelitis without general vascular insufficiency occur?

A

About 1 month after primary cause of infection

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31
Q

Presentation & Sequelae of Contiguous-Focus Osteomyelitis without General Vascular Insufficiency

A

P: pain, fever, drainage of area
S: decreased bone stability, necrosis, & soft tissue damage

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32
Q

Most Common Bugs with Contiguous-Focus Osteomyelitis with General Vascular Insufficiency

A

Staph
Strep
Enterococcus
G-bacilli

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33
Q

Presentation of Contiguous-Focus Osteomyelitis with General Vascular Insufficiency

A

Ulcers
Multiple foot problems
DM

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34
Q

Chronic OSteomyelitis

A

H/O osteomyelitis
Recurrence of pain, fever, drainage, erythema, & swelling
Nidus of infection must be removed
Prolonged can develop SCC or amyloidosis

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35
Q

Diagnosis of Musculoskeletal Infections in Adults

A

H&P
Labs
Imaging
Osteomyelitis: great mimicker

36
Q

Treatment of Musculoskeletal Infections in Adults

A

Antibiotics: 4-6 weeks
Adequate drainage, debridement, dead space management, maintenance of blood supply/wound care
Treat systemic issues

37
Q

Treatment of Musculoskeletal Infections in Adults from Last Debridement

A

Stage 1: medullary (4 weeks antibiotics)
Stage 2: superficial (2 weeks antibiotics)
Stage 3: localized (4-6 weeks antibiotics)
Stage 4: diffuse (4-6 weeks antibiotics)

38
Q

Treatment of Musculoskeletal Infections in Adults When Surgery is not an Option

A

Rifampin + fluoroquinolone or Bactrim for 6 months

Possible long term suppression

39
Q

Surgical Debridement of Musculoskeletal Infections

A

Complete when bone bleeds “paprika sign”
Dead = remove
FB = remove
Bony defects: autograft or ex. fix

40
Q

Alternative Treatment of Musculoskeletal Infections in Adults

A

Antibiotic impregnated beads: high concentrations of antibiotics &
fills dead space
Antibiotic pumps

41
Q

Can fractures heal in the setting of infection?

A

Yes
Stable better than unstable
Int./Ex. fixation

42
Q

Types of Coverage of Soft Tissue Injuries

A

Wound pumps
Flaps
Skin grafts
Avoid secondary intention

43
Q

Hyperbaric Oxygen Therapy for Musculoskeletal Infections in Adults

A

Useful for chronic osteomyelitis & soft tissue injuries

44
Q

Benefits of Hyperbaric Oxygen Therapy in Musculoskeletal Infections in Adults

A

Promotes collagen formation & angiogenesis

Increases oxygen tension in soft tissues

45
Q

Cons to Hyperbaric Oxygen Therapy in Musculoskeletal Infections in Adults

A

Expensive

Multiple sessions

46
Q

Possible Routes of Adult Septic Osteoarthritis

A

Blood
Trauma
Contiguous spread
IVDU

47
Q

Predisposing Factors for Adult Septic Arthritis

A 
DM
Rheum
Steroid use
HIV
Malignancy
Age
48
Q

Most Common Joint Affected from Adult Septic Arthritis

A

Knee

49
Q

Pathophysiology of Adult Septic Arthritis

A

Destruction of synovial cell lining
Glycosaminoglycan destruction
Increase inflammatory response
Destruction of cartilage

50
Q

Most Common Organisms for Adult Septic Arthritis

A 
N. gonorrhea
S. aureus (IVDU)
E. coli
Pseudomonas
Fungal (HIV)
51
Q

Presentation of Adult Septic Arthritis

A

Warm, swollen, & painful joint

52
Q

Infectious Blood Work for Adult Septic Arthritis

A

CBC
ESR
CRP

53
Q

What are we looking for when we send an aspiration sample?

A

Cell count with differential
Crystals
Gram stain
Cultures

54
Q

Treatment of Adult Septic Arthritis

A

Surgery
Immediate antibiotics
Arthrotomy & debridement
NSAIDs: decreases cartilage damage

55
Q

Most Common Location of Musculoskeletal Infections in Pediatric Patients

A

High vascular areas at the metaphysical epiphyseal are

56
Q

Most Common Organisms for Pediatric Musculoskeletal Infections

A 
S. aureus
Group A strep
H. influenza
Kingella kingae (URI presentation)
Salmonella (sickle cell)
Bartonella henselae (cat scratch disease)
P. aeruginosa (feet)
57
Q

Pathophysiology of Osteomyelitis in Neonates

A

Infection perforates periosteum

Spreads to surrounding tissue & joints

58
Q

Pathophysiology of Osteomyelitis in Infants

A

More rare due to metaphyseal capillary atrophy

59
Q

How is osteomyelitis spread limited in children?

A

Thickening of the cortex of bones

60
Q

Diagnosing Musculoskeletal Infections in Pediatrics

A

Fever + limb pain for 3+ days needs evaluation

61
Q

Presentation of Musculoskeletal Infections in Neonates

A

Pseudoparalysis
Pain with palpation
Swelling
Decreased appetite

62
Q

Presentation of Musculoskeletal Infections in Infants, Toddlers, & Young Children

A 
Fever of Unknown Origin
Limp or non-weight bearing
Swelling
Warmth
Erythema
63
Q

Presentation of Musculoskeletal Infections in Older Children & Adolescents

A

Constant localized pain

Fever

64
Q

Diagnosis of Pediatric Musculoskeletal Infections

A

Blood cultures
US: hips
MRI with gadolinium

65
Q

Treatment of Pediatric Musculoskeletal Infections

A

Antibiotics (4-6 weeks)

Decompression & drainage of infected area

66
Q

Antibiotics Need to Cover What Organisms

A

Staph

Group B strep

67
Q

Treatment of Chronic Osteomyelitis

A

I&D

Antibiotics: 6-12 months

68
Q

Most Common Organisms for Pediatric Septic Arthritis

A

S. aureus
Group B strep (neonates)
Gram negative bacilli (neonates)

69
Q

Presentation of Pediatric Septic Arthritis

A 
Fever
Edema
Erythema
Effusion
Refusal to ambulate
Pseudo paralysis
After 72 hours of infection
70
Q

Presentation of a Pediatric Septic Hip Arthritis

A

Flexed
Abducted
External rotation
Severe pain with PROM & rotation

71
Q

Diagnosis of a Pediatric Septic Hip Arthritis

A

Infectious blood work
Plain films: r/o other diagnoses
Hip aspiration (gold standard-impractical)
Hip US: sagging rope sign

72
Q

Treatment of Pediatric Septic Arthritis

A

Antibiotics: 3+ weeks

Drainage of joint

73
Q

Possible Sequelae of Pediatric Septic Arthritis

A

Potential growth plate disturbances

74
Q

Most Common Organisms in Periprosthetic Infections

A

S. aureus

S. epidermadis

75
Q

How to periprosthetic infections occur?

A

Direct contact in surgery
After surgery (draining incision)
Hematogenous inoculation

76
Q

Symptoms of Periprosthetic Infections

A

Pain not changed by activity levels
Stiffness
Chronic drainage

77
Q

Diagnosis of Periprosthetic Infections

A 
Symptoms
Infectious labs
Aspiration
Plain radiographs (late finding)
Bone scan: "hot spot"
Indium-111 nuclear scan
78
Q

Short Term Periprosthetic Infections

A

Less than 4-6 weeks post surgery

Hematogenous spread

79
Q

Long Term Periprosthetic Infections

A

> 4-6 weeks after surgery
No inciting event
Chronic pain

80
Q

Treatment Options for Periprosthetic Infections

A 
Antibiotics alone
Single stage revision
2 stage revision
Amputation
Fusion
81
Q

Single Stage Revision for Periprosthetic Infections

A

Short term infections
Surgical debridement
Antibiotics 6 weeks (2 drugs)
Single oral therapy for at least 1 year

82
Q

Two Stage Revision for Periprosthetic Infections

A 
Long term infections
Surgical debridement
Antibiotic cement spacer
Antibiotics 6 weeks
Antibiotic holiday (2 weeks)
Infectious blood work
"Normal" blood work- revision arthroplasty
Abnormal blood work- start over with surgical debridement
Year of antibiotics
83
Q

Indications for Amputations in Periprosthetic Infections

A

Life-threatening sepsis
Multiple failed revisions
Persistent severe pian

84
Q

Indications for Fusion in Periprosthetic Infections

A 
Total knee arthroplasty
High functioning patients
Single joint
Young patient
Loss of extensor mechanism
85
Q

Prevention of Periprosthetic Infections

A

Antibiotic prophylaxis for invasive procedures for life

Antibiotics: amoxicillin, cephalosporin, or clindamycin

Ortho (22 decks)

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